光谱CT细胞外体积分数术前诊断结直肠癌病理T分期及组织学分级的价值  

The Value of Spectral CT Extracellular Volume Fraction in Preoperative Diagnosis of Pathological T Stage and Histological Grade of Colorectal Cancer

作　　者：孙琦 孙丹琦 卞雪莲 王咪 董瀚韵 郭秋辰 戴晓晓 吴永友[4] 张力元[1] 范国华[1] 李勇刚[2] 陈光强[1] SUN Qi;SUN Dangqi;BIAN Xueian(Department of Radiology,The Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu Province 215004,P.R.China)

机构地区：[1]苏州大学附属第二医院放射科,215004 [2]苏州大学附属第一医院放射科,215006 [3]苏州大学附属第二医院病理科,215004 [4]苏州大学附属第二医院普外科,215004

出　　处：《临床放射学杂志》2024年第5期782-787,共6页Journal of Clinical Radiology

基　　金：中核医疗产业有限公司技术创新专项(编号:ZHYLTD2021001);江苏省科技厅社会发展重点项目(编号:BE2021652)。

摘　　要：目的探讨基于结直肠癌(CRC)病灶的光谱CT细胞外体积分数(ECV)术前诊断CRC病理T分期及组织学分级的价值。方法回顾性连续搜集2022年6月至2022年12月苏州大学附属第二医院和苏州大学附属第一医院经病理证实的112例CRC患者的临床、病理资料及术前光谱CT图像。测量并分析病灶增强三期的光谱CT定量参数,包括动脉期及静脉期的40 keV、100 keV虚拟单能级图像(VMI)的CT值、碘浓度(IC)值、有效原子序数(Eff-Z)值及延迟期的ECV值。肿瘤的T分期及分级情况由手术病理获得。采用独立样本t检验或Mann-Whitney U检验比较在不同病理T分期及组织学分级中各参数的差异,采用Spearman相关分析定量评价T分期与各参数的相关性,对有组间差异的参数绘制受试者工作特征(ROC)曲线以评价诊断效果。结果T3期肿瘤的光谱CT各定量参数值均高于T1-2期肿瘤,且均存在统计学差异(P均<0.05)。Eff-ZAP、ICAP、CT40 keVAP、CT100 keVAP、Eff-ZVP、ICVP、CT40 keVVP、CT100 keVVP、ECV与T分期均呈中度相关(0.4<r<0.75),且ECV与T分期的相关性最高(r=0.602)。高级别组肿瘤的Eff-ZAP、ICVP、CT100 keVVP、ECV值均高于低级别组,差异均具有统计学意义(P均<0.05)。ECV术前对结直肠癌病理T分期、组织学分级的诊断效能均较高,AUC值分别为0.885、0.738。结论光谱CT ECV可用于术前诊断结直肠癌病理T分期及组织学分级,且较光谱CT常规定量参数诊断效能更优,能为CRC术前评估提供一个新的、无创的影像标记物,有助于更早期、精准地制定个体化的治疗方式。Objective To investigate the value of spectral CT extracellular volume fraction in preoperative diagnosis of pathological T stage and histological grade of colorectal cancer.Methods The clinical,pathological data and preoperative spectral CT images of 112 patients with pathologically confirmed colorectal adenocarcinoma in the Second and First Affiliated Hospital of Soochow University from June 2022 to December 2022 were retrospectively collected.The quantitative parameters of spectral CT in three enhanced phases of the lesion were measured and analyzed,including CT value,iodine concentration(IC)value,effective atomic number(Eff-Z)value of 40 keV and 100 keV virtual monoenergetic images(VMI)in arterial phase and venous phase,and extracellular volume fraction(ECV)value in delayed phase.The T stage and histologicalgrade of the tumor was obtained by surgical pathology.Independent sample t test or Mann-Whitney U test was used to compare the differences of parameters in different pathological T stages and histological grades.Spearman correlation analysis was used to quantitatively evaluate the correlation between T stages and parameters.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic effect of parameters with differences between groups.Results The spectral CT quantitative parameters of T3 tumors were higher than those of T1-2 tumors,and the differences were statistically significant(all P<0.05).Eff-Z_(AP),IC_(AP),CT 40 keV_(AP),CT 100 keV_(AP),Eff-Z_(VP),IC_(VP),CT 40 keV_(VP),CT 100 keV_(VP),ECV were moderately correlated with T stage(0.4<r<0.75),and ECV had the highest correlation with T stage(r=0.602).The Eff-Z_(VP),IC_(VP),CT 100 keV_(VP) and ECV values of the high-grade group were higher than those of the low-grade group,and the differences were statistically significant(all P<0.05).The preoperative diagnostic efficacy of ECV for pathological T stage and histological grade of colorectal cancer was high,with AUC values of 0.885 and 0.738,respectively.Conclusion Spectral CT extrac

关 键 词：光谱CT 细胞外体积分数 结直肠癌 病理T分期 组织学分级 

分 类 号：R735.34[医药卫生—肿瘤] R730.44[医药卫生—临床医学]